There have been no major therapeutic advances to improve BV cure rates for over two decades, suggesting that a variety of approaches may be needed, including antimicrobials to disrupt biofilms, non-drug treatments, and treatments for partners.¹³

The BNF advises against the use of intra-vaginal preparations in young girls, especially where an applicator is needed unless no alternative is suitable. It also advises against using intravaginal preparations in menstruation.¹²

Pregnant women may need longer doses of intravaginal imidazole treatments - typically around seven days.¹² However, NICE advises against the use of oral treatments for vaginal candidiasis in pregnancy.¹⁸ It also says: "Pregnant women should not be offered routine screening for BV because the evidence suggests that the identification and treatment of asymptomatic BV do not lower the risk of preterm birth and other adverse reproductive outcomes."¹⁹

Dequalinium chloride activity is impaired by anionic substances such as soaps, detergents, and surfactants, so women should be advised against intravaginal use of soaps, spermicides, or vaginal douches. While dequalinium chloride does not impair the functionality of latex condoms, there is as yet no data on the interaction with non-latex condoms and other intravaginal devices such as diaphragms.¹⁵ Clindamycin gel can damage latex condoms and diaphragms.¹²

The NHS advises against using products with potential irritants, such as perfumed soaps, shower gels, vaginal deodorants, wipes, or douches. Once-daily washing around the vagina with water and an emollient is suitable, and avoiding tight-fitting underwear or tights may also help.²⁰ Women with diabetes should ensure they keep blood sugar levels under control.